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Asthma Management - Science topic

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Antihistamines block the actions of histamine and also have effects on inflammation which is independent of histamine-H(1)-receptor antagonism. Many physicians prescribe antihistamines for asthma patients. However, recent studies have shown that controlling allergic rhinitis with antihistamines has a small, indirect effect in improving asthma symptoms.
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No, antihistamines do not improve bronhial asthma. Some benefits could be present in rhinitis, asociated to asthma.
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There are several papers addressing asthma management self-efficacy (confidence) among nurses specifically, and other health care providers generally. However, trying to get in contact with them to obtain theses validated tools but could not get a response.
"Developing a scale to measure self-efficacy on asthma teaching for health care providers"
"Asthma management efficacy of school nurses in Taiwan"
These are some of those papers. Can anyone assist me to obtain the tool? and getting in contact with those authors
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That was really really helpful Garry McDonald
I appreciate that
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I am looking for a tool that will assist in exploring school nurses needs, roles, functions, and responsibilities in relation to asthma management?
Can anyone recommend a tool?
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You can designed a new developed tools
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Asthma medications are classified as " reliever" and "controller" medications.
Is asthma management always a combination of the two types?
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Dear Ramachandra, 
Thank you for this interesting question. 
As you describe, asthma management is a combination of these two factors, but it´s important to have in mind that the therapeutic options in both approaches are varied. But also, not only these medications are considered useful for the asthma management. Environmental control and health promotion programs for asthma are fundamental aspects of the control of this disease. 
You can get more resources about this approach in the GINA Website.
Best, 
Juan Yepes
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I am looking into the compliance rate of asthma action plans in the pediatric patient population. How useful are they. Are there results from focus groups regarding asthma action plans?
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pediatrics asthma guidelines are to some extent similar to adults.you can use the following guideline too.
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In asthmatic children whose symptoms are uncontrolled on standard doses of inhaled corticosteroids (ICS), guidelines recommend to either increase the ICS dose or to add further controller medication, e.g. a long acting beta-agonist (LABA)
Is it important to follow the stepwise approach in treating Adults and children with asthma which almost all international guidelines recommend, or is it ok to change it around if you see that it works best!
In addition, In Bahrain, in the primary health care setting precisly, physicians tend to 'skip' starting with mono therapy (ICS) and start directly with combination Tx like seretide Diskus, patients find it easier to use and they get better on so many levels,, so is that ok?
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Well despite the Guidelines which we often forget are just that and do not equally apply to all patients--I prefer an individualized approach.
I am assuming This is a child old enough to do pulmonary function tests--if so the results can guide you,  The paient is having syptoms--yes? If the Pulmonary Function Test is fairly normal(=/> 80%) then this tell me that they do not need a LABA but more ICS .  One reason they may need more they are not taking correctly what they have been given---not inhaling correctly --and/or using less frequent doses than recommended.  Before increasing the dose check what they are doing---and remember patients do not always tell you the entire truth.
Even before adding a LABA, if the Mid Flow Rates (FEF 25-75%) are low consider the small airways may not be getting the ICS because some ICS have too large of a particle size to reach the small airway--So switch brands or delivery system. ( Dry Power Inhalers have the largest particle size so switching to a MDI/HFA system may be enough.
If one needs to increase the dose of ICS --I would never go above the recommended dose without careful adverse effect monitoring (Growth) and ruling out (??even again) that there is NOT something other than or in addition to Asthma going on.
Finally remeber that not all Asthma Patients respond to ICS equally---see the new GINA Guidelines on Heterogenity.
Good Luck
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I have observed patients with bronchial asthma, be initially treated with budesonide which after a period of use becomes ineffective. They are then switched over to formoterol for a while and eventually to salmeterol. What will they be treated with after salmeterol?
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Response to ICS may show variability over time in some asthma patients, but development of total resistance to ICS in a patient previously considred as good responder should be considered an exceptional case.
Short term reduction in the response ot ICS can be seen in asthma patients suffering viral infections.Recent studies have shown that viral infections can reduce the antiinflammatory effects of glucocorticoids (GC) by altering the GC receptor function (see Elena Goleva sudies). Exposure to potent allergens at home (cats ,hamster, etc) or to occupational allergens or irritative substances may also explain an apparent reduction in the response to ICS.
As Dr Kodgule pointes out a limited efficacy of ICS to prevent progressive decline in lung function test is frequently detected in the follow-up of asthma patients. This observation suggests that ICS are very useful to prevent asthma exacerbations, reduce mortality and increase the quality of life of patients, but are less efective to prevent remodelling and therefore progression in airway obstruction.
Finally, when a patient develops refractoriness to ICS, poor compliance is the most frequent explanation in clinical practice.
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Fixed airflow obstruction is a clinical subtype or phenotype of Difficult-to-treat Asthma. Is there any specific spirometry criteria on which we can tell of having fixed air-flow limitation in Asthma?
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Reversible airflow obstruction in Bronchial Asthma is defined as increase in FEV1 by > 200 ml & FEV1 > 12% post bronchodilator challenge . COPD is defined as post bronchodilator FEV1 / FVC < 0.7 which confirms that airflow obstruction is not fully reversible . If there is no post bronchodilator reversibility in bronchial asthma , it should be considered as fixed air flow obstruction . The main problem is that if spirometric findings of Bronchial Asthma is suggestive of COPD in elderly patients , it is difficult to diagnose the Asthma component ,unless the history of childhood wheeze , allergy , dry cough & non smoking is available
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Inhaled corticosteroids are the key controllers in Asthma but the long term use is linked to some important side-effects.
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discontinuation of the ICS in patients showing controlled asthma for e.g. 3 months is the option indicated in the guidelines leading to the minimum possible therapy (fast-acrting bronchodilator alone as needed) btu the evidence is D. However, there is increasing evidence supporting the intermittent as needed use of fixed combinations of ICS and rapid-acting bronchodilators (e.g. salbutamol or formoterol) which has several advantages over the single bronchodilaotr monotherapy. first of all asthma is an inflammatory disease and even if symptoms are infrequernt and lung function is normal, inflammation has to be addressed. Leaving a patient with rescue bronchodialtor only as antiasthmatic therapy is nowadays, not the best option in my opinion.
rescue use of fawst-acting bronchodilartor/ICS combination allows the patient to have a symptom-drtiven treatment and adjust the need in case of symptoms increase. The ICS in the combination can have a rapid effect on the flares of inflammation leading to symptoms increase and can contribute avoiding the acute worsening of the disease.
Moreover, a patient with as needed bronchiodilator alone therapy would need to be mnonitored frequently to check if the use is more than twice a week in order to consider a step-up in therapy.
to make a long story short I do not think stopping ICS is a good option.
A useful reading: Rescue treatment in asthma. More than as-needed bronchodilation. Papi A, Caramori G, Adcock IM, Barnes PJ.
Chest. 2009 Jun;135(6):1628-33.
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In the case where one does not have adrenaline available, how effective is Iv aminophylline? What are other alternatives?
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" Our update in 2012 is consistent with the original conclusions that the risk-benefit balance of intravenous aminophylline is unfavorable." (Ref: Parameswaran Nair,, Stephen J Milan, Brian H Rowe ,.Addition of intravenous aminophylline to inhaled beta2-agonists in adults with acute asthma, Editorial Group: Cochrane Airways Group, DOI: 10.1002/14651858.CD002742.pub2 )
IV Magnesium sulphate is an alternative if other treatments like beta agonists and steroids do not produce good response.
(Ref: W. F. S. Sellers, Inhaled and intravenous treatment in acute severe and life-threatening asthma, Br. J. Anaesth. (2012) doi: 10.1093/bja/aes444 )
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Pictorial based education might help in those with low health literacy.
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ictorial based asthma self management plans may be used as an additional tool during a consultation to improve compliance and understanding or to provide self-management education. Other tools and information during consultations can improve compliance and understanding, such as provision of leaflets, pictorial aids and diagrams and providing further information links and leaflets post consultation. It has been shown that these consultation tools improve understanding for all patients as well as those with low literacy skills.